Home-based telerehabilitation in older patients with chronic obstructive pulmonary disease and heart failure: a randomised controlled trial

Age Ageing. 2018 Jan 1;47(1):82-88. doi: 10.1093/ageing/afx146.

Abstract

Background: chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) frequently coexist in older people, reducing patients' quality of life (QoL) and increasing morbidity and mortality.

Objective: we studied the feasibility and efficacy of an integrated telerehabilitation home-based programme (Telereab-HBP), 4 months long, in patients with combined COPD and CHF. The primary outcome was exercise tolerance evaluated at the 6-min walk test (6MWT). Secondary outcomes were time-to-event (hospitalisation and death), dyspnoea (MRC), physical activity profile (PASE), disability (Barthel) and QoL (MLHFQ and CAT).

Study design: randomised, open, controlled, multicenter trial.

Methods: the Telereab-HBP included remote monitoring of cardiorespiratory parameters, weekly phone-calls by the nurse, and exercise programme, monitored weekly by the physiotherapist. All outcomes were studied again after 2 months of a no-intervention period.

Results: in total, 112 patients were randomised, 56 per group. Their mean (SD) age was 70 (9) years, and 92 (82.1%) were male. After 4 months, the IG were able to walk further than at baseline: mean (95% CI) Δ6MWT was 60 (22.2,97.8) m; the CG showed no significant improvement: -15 (-40.3,9.8) m; P = 0.0040 between groups. In IG, the media time to hospitalisation/death was 113.4 days compared with 104.7 in the CG (P = 0.0484, log-rank test). Other secondary outcomes: MRC (P = 0.0500), PASE (P = 0.0015), Barthel (P = 0.0006), MLHFQ (P = 0.0007) and CAT (P = 0.0000) were significantly improved in the IG compared with the CG at 4 months. IG maintained the benefits acquired at 6 months for outcomes.

Conclusions: this 4-month Telereab-HBP was feasible and effective in older patients with combined COPD and CHF.

Keywords: chronic heart failure; chronic obstructive pulmonary disease; home rehabilitation; older people; telemedicine services.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Cardiac Rehabilitation / adverse effects
  • Cardiac Rehabilitation / methods*
  • Cardiac Rehabilitation / mortality
  • Disability Evaluation
  • Exercise Therapy / adverse effects
  • Exercise Therapy / methods*
  • Exercise Therapy / mortality
  • Exercise Tolerance
  • Feasibility Studies
  • Female
  • Geriatric Assessment / methods
  • Heart Failure / diagnosis
  • Heart Failure / mortality
  • Heart Failure / physiopathology
  • Heart Failure / rehabilitation*
  • Home Care Services, Hospital-Based*
  • Humans
  • Italy
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Patient Admission
  • Pulmonary Disease, Chronic Obstructive / diagnosis
  • Pulmonary Disease, Chronic Obstructive / mortality
  • Pulmonary Disease, Chronic Obstructive / physiopathology
  • Pulmonary Disease, Chronic Obstructive / rehabilitation*
  • Quality of Life
  • Recovery of Function
  • Respiratory Therapy / adverse effects
  • Respiratory Therapy / methods*
  • Respiratory Therapy / mortality
  • Risk Factors
  • Surveys and Questionnaires
  • Telerehabilitation / methods*
  • Time Factors
  • Treatment Outcome
  • Walk Test